A middle-aged black African male carpenter (age 60) who had been experiencing difficulties breathing and a dry cough for three days was taken to the emergency room on September 2, 2022. The hospitalized patient had a two-day history of weakness, dizziness, and malaise. He had never before used any nephrotoxic medications. He had no prior history of sepsis, heart failure, shock, cirrhosis, or bilateral renal artery stenosis. The patient who was hospitalized had a history of medicines and medical conditions. He didn't come from a medically or pharmaceutically inclined household. He did not exhibit any signs of recent intense exercise, alcohol consumption, or urine urgency or dysuria. Five days prior to being admitted, he had a history of using public transportation to travel outside of the city to another town to visit his siblings while not wearing a face mask. He had never before experienced a COVID-19 infection or a chronic renal condition. He had previously had stage-I hypertension three years prior and had been treated with amlodipine 5 mg orally once daily and hydrochlorothiazide 25 mg orally once daily. Before being admitted, he had taken his antihypertensive medications consistently.
When he arrived at the emergency room, he had two days' low urine output, weight loss, cold intolerance, dehydration, stress, fever, and blood in his urine. Seven days before being admitted, he was in good health low urine output, weight loss, cold intolerance, dehydration, stress, fever, and blood in his urine. Seven days before being admitted, he was in good health. His vital signs at the emergency room were 38.8°C body temperature, 79 kg weight, 1.75 m height, 25.8 kg/m2 body mass index, 102 beats per minute peripheral pulse, 144/97 mmHg blood pressure, 20 breaths per minute respiratory rate, and 87% oxygen saturation on ambient air.
His blood chemistry done upon his admission in emergency department showed blood urea nitrogen of 41 mg/dl, fasting blood glucose of 117 mg/dL, a 2-hour postprandial blood glucose of 156 mg/dL, serum sodium of 121 mEq/L, serum potassium of 7.1 mEq/L, Hb 12.7 g/dL, leukocytes of 4,340/µL, polymorphonuclear leucocytosis with 1850 neutrophils per microliter of blood (normal value: 2,500-7,000 neutrophils per microliter of blood), platelets of 139,800/µL, neutrophils 70%, pH arterial blood of 7.07 (normal value: 7.32-7.43), anion gap level of 23 mEq/L (normal value: 3-10 mEq/L), partial pressure of carbon dioxide of 32 mmHg (normal value: 38-42 mmHg), serum bicarbonate level of 20.0 mEq/L (normal value: 22-29 mEq/L), plasma creatinine of 2.7 mg/dL, glomerular filtration rate of 32.5 mL/min, serum phosphate level of 2.6 mg/dL (normal value: 2.8-4.5 mg/dL), white blood cell count of 18750 cells/mm3 (normal value: 4500-11000 cells/mm3), serum chlorine level of 94 (normal value: 96-106 mEq/L), an aspartate aminotransferase level of 61 units/L (normal value: 0 - 35 units/L), an alanine aminotransferase level of 79 units/L (normal value: 0 - 35 units/L), an erythrocyte sedimentation rate of 15 mm/hour (normal value: 0 - 20 mm/hr), 45% hematocrit (normal value: 39% - 49%), lymphocytes 17%, urine volume of 1450 mL per day, troponin T level was normal, and urine analysis was positive for urine ketones of 2+. After being admitted, he received five liters of intranasal oxygen per minute for three hours before being transported to an intensive care unit.
The results of his neurological test showed a Glasgow coma scale of 10/15. The first chest radiograph revealed multifocal, patchy airspace illness, which was suggestive of atypical pneumonia or viral infection, specifically COVID-19.A sinus tachycardia was discovered on his electrocardiogram, with an ST-segment of 0.06 seconds and a heart rate of 110 beats per minute (normal range: 60-100 beats per minute) (the normal range of the ST-segment is ordinarily around 0.08 second). He has never made prior, approved COVID-19 contact. routine reverse transcription polymerase chain reaction (RT-PCR) COVID-19 testing in the emergency room; the results were positive, and he was subsequently hospitalized in the critical care unit.
After spending thirty hours in the emergency room and testing positive for SARS-CoV-2 virus, he was transferred to an intensive care unit with prior diagnoses of managed stage I hypertension, new onset prerenal acute kidney damage, and recently confirmed COVID-19 infection.
As part of the procedure for managing SARS-CoV-2 at the time of his admission, he began oxygen saturation with five liters of oxygen administered through a nasal cannula. He received a bolus of 1 L of ringer lactate upon admission to an intensive care unit, followed by 400 mL/hour of maintenance lactated ringer. He was anuric for the first day. On the second day after the initial 24 hours, his urine production climbed to 800 mL over 12 hours. He did not require continuous renal replacement therapy because his kidney indices were stable and his urine output increased to near-normal levels within 24 hours. He was given frusemide 40 mg/2 mL intravenously twice a day for three days to increase urine output, flow, and debris flushing. He was given subcutaneous enoxaparin 80 mg 12 hours a day for her confirmed COVID-19. To reduce hospital-acquired infections, he was given a broad-spectrum antibiotic such as 500 mg of azithromycin once a day for five days and 1 g of intravenous ceftriaxone daily for three days in a row. He was given 500 mg of acetaminophen as needed to reduce COVID-19 infection-related fever.
Outcome and follow-up
He managed his blood pressure effectively with antihypertensive drugs and dietary changes after nineteen days in the hospital. The Cockcroft-Gault equation was used to assess her estimated glomerular filtration rate prior to discharge, which resulted in a relative glomerular filtration rate of 61 mL/min/1.73 m2. On September 21, 2022, the patient was discharged from the hospital after two consecutive negative throat swab tests for COVID-19 infection. He was released while still on his original antihypertensive medications. He was advised to continue monthly follow-ups at the ambulatory clinic.